Is heart stent a technology that has been eliminated abroad? Rumors, debunked!

[This issue's rumors]:

Heart stent surgery is one of the important means of treating coronary heart disease, but it has always been plagued by rumors.

Recently, several surgical animation videos claiming to be "black technology to replace heart stents" have once again spread on the Internet. Rumor has it that heart stents are a technology that has long been eliminated abroad, and new thrombus aspiration and vascular ablation techniques are now popular abroad.

① New thrombus aspiration technique. The video introduction states, "The thrombus is fixed by the guidewire and pushed into the catheter. The completely blocked blood vessel can be easily and quickly unblocked in just a few tens of seconds, leaving no trace, eliminating the pain of implanting a stent."

New thrombus aspiration technique (video from the Internet)

② New vascular ablation. The video is accompanied by the caption, "Heart stents are a technology that has long been eliminated abroad. This is a foreign ablation technique for blockages in blood vessels. A grinding probe can be used to remove plaques in the heart and blood vessels in one go."

New vascular ablation technique (video from the Internet)

After watching the video, many friends were very excited, thinking that they could finally say goodbye to heart stents. This high-tech is really amazing!

【NetEase Health Assessment】：

rumor!

【Guidance Expert】

Sun Hongtao, Chief Physician of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences

【Rumor Identification Points】:

1. Thrombus aspiration has been around for a long time and is not a new technology. It cannot replace heart stents.

Thromboaspiration is a coronary interventional treatment method that uses the principle of negative pressure aspiration to suck out blood clots through a suction catheter. It has a history of several decades abroad and is not a new technology.

The blood vessels shown in the video are smooth and elastic, and do not look like real diseased blood vessels.

What do diseased blood vessels really look like? Normal and healthy blood vessels are indeed smooth and elastic, but when the blood vessel wall is damaged, the components in the blood will penetrate through the damage and hide under the inner membrane of the blood vessel wall, and small lumps will appear in the blood vessels. Over time, the blood vessels will be filled with lumps and bumps, just like cooked millet porridge, which is atherosclerosis .

These small lumps are called plaques . As plaques grow larger, they can directly block blood vessels. Plaques may also be lifted up and form blood clots (thrombosis occurs on the basis of atherosclerosis). The blood clots are swept into the blood and run wildly everywhere. Wherever they get stuck, they will block the blood vessels, causing terrible consequences.

The effects shown in the video are very different from the actual clinical effects.

First, blood clots will not stay still. When a device is placed in the human body, the blood clots may move to the far end or turn into more small blood clots. Therefore, in clinical practice, blood clots are not 100% sucked out. Secondly, assuming that the blood clots can be completely sucked out, but the plaques are still in the body, blood clots will form again after the plaques rupture.

In short, although blood clots can be aspirated, vascular stenosis caused by atherosclerosis is not affected by blood clot aspiration. For most patients with myocardial infarction, stents still need to be installed.

2. The so-called new vascular ablation technique is actually a stone surgery.

The "pipes" shown in the video are not blood vessels in the heart, but the human urinary system (kidneys, ureters). When there are stones in the kidneys or ureters, lasers, ultrasound and other means will be used to break up and remove the stones as shown in the video. However, the actual clinical lithotripsy is not as perfect as shown in the video.

There is indeed a similar technology in the treatment of coronary heart disease, called coronary artery plaque atherectomy . However, plaque atherectomy has obvious disadvantages, such as severely calcified plaques cannot be atherectomized at all, and there is a risk of vascular perforation during atherectomy . Therefore, plaque atherectomy is not widely used in actual clinical practice.

3. Heart stent surgery is not outdated, but has been "advancing".

People’s fear of diseases and foreign objects in their bodies is the breeding ground for rumors. “After a stent is installed, the person will be disabled”, “Putting a stent is purely for the doctor’s personal gain” and other similar statements have “demonized” heart stents.

Man-made medical devices are never black and white, they are neither gods nor monsters. It is true that heart stents have a definite effect, but they are also just a "post-80s" product, which has been "advancing" since its birth in 1986.

Version 1.0: Bare Metal Stents (1986-2001)

In 1986, French doctor Ulrich Sigwart found a memory metal to make a heart stent, and implanted the first bare metal stent into the coronary artery through a catheter.

Soon after, doctors discovered that bare metal stents had obvious defects. Due to proliferative changes in the intima at the site of stent implantation, the probability of recurrence of coronary heart disease due to restenosis within the stent after surgery was 20%-30%, and long-term use of antiplatelet drugs by patients was prone to bleeding complications.

Version 2.0: Drug-eluting stents (2001-2011)

In order to solve the problems left over from the first generation of stents, more research and experiments were conducted around the world. In 2001, the European Society of Cardiology announced the development results of a new stent - drug-eluting stent, which opened up a new era for the second generation of stents.

The basic principle of drug-eluting stents is to load some drugs with anti-coagulation or anti-tissue cell proliferation on the metal stent, so as to reduce the rate of restenosis of blood vessels after surgery to 5%-10%. According to statistics, the use rate of drug-eluting stents in the United States accounted for 28% of patients with heart stent implantation in 2003, and it was as high as 91% in 2005.

At present, drug-eluting stents are the mainstream technology in the global market and the most commonly used type of heart stents in clinical practice. However, the problem of long-term stent thrombosis is still an inevitable defect.

Version 3.0: Biodegradable Stents (2011-Present)

The design concept of biodegradable stents is that after achieving the effect of dilating narrowed blood vessels and releasing anti-restenosis drugs, the stents can gradually degrade and be completely absorbed by the tissues, restoring the blood vessels to their natural state, thus avoiding problems such as restenosis and late thrombosis caused by traditional non-degradable stents. In short, the stents "retire" after completing the task of "remodeling blood vessels".

At present, many large pharmaceutical companies around the world have produced biodegradable stents with their own characteristics, further promoting the development of coronary interventional treatment.

So far, heart stent surgery is an important means to save the lives of patients with coronary heart disease, both at home and abroad. In 2010, former US President Clinton had two heart stents implanted in New York due to chest pain; in 2013, former US President Bush Jr. underwent heart stent surgery due to coronary artery disease; in 2019, US presidential candidate Bernie Sanders had two heart stents implanted during his campaign speech due to sudden chest pain.

After knowing these key facts, you can clearly tell that the so-called "heart stents are a technology that has been eliminated abroad" is pure nonsense! Blindly rejecting heart stents at a critical moment often costs lives.